Mental Health, Substance Abuse Reforms Get Approval
In the waning hours of the 2016 legislative session, Florida lawmakers Friday approved wide-ranging reforms to the state's mental-health and substance-abuse treatment systems.
House members voted 118-1 to approve the proposal (SB 12) after it had bounced back and forth between the chambers throughout the week. A similar bill died last spring during the chaotic end of the 2015 legislative session.
"It's been a long, hard road," said House Children, Families and Seniors Chairwoman Gayle Harrell, a Stuart Republican who was heavily involved in developing the measures.
Mark Fontaine, executive director of the Florida Alcohol and Drug Abuse Association, she he thinks policymakers "are beginning to really understand the impact of mental health and substance abuse on the entire system."
"They're understanding the impact on the courts … the child welfare system … and the health care system," Fontaine said.
The focus of this year's bill is a "no wrong door" policy, so that people who need mental-health or substance-abuse treatment can get it no matter how they enter the systems --- whether through criminal offenses or personal crises.
To do that, the bill would create central receiving facilities to function as single points of access to emergency care and intervention services.
The bill also would "align" the Baker Act and the Marchman Act, two state laws dealing with involuntary commitment.
The Baker Act allows for involuntary examination or commitment if people are likely to have mental illnesses that pose harm to themselves or to others. The process must be initiated by judges, law enforcement officers, physicians or mental-health professionals. The Marchman Act allows for the involuntary commitment of Floridians undergoing substance-abuse crises.
Last year, Senate sponsor Rene Garcia, R-Hialeah, tried for a flat-out merger of the Baker and Marchman acts, but the House would not go along.
The Baker and Marchman acts differ in terms of which facilities may receive people in crisis, who can provide assessments and evaluations, the time permitted to conduct involuntary examinations and the authority to release people after they are stabilized.
Crucially, the two acts also differ widely in terms of funding.
This year's bill doesn't create a merger, Garcia said, but an alignment of the timelines and legal processes for assessment, evaluation, and receipt of available services under the Baker and Marchman acts to help people in recovery and keep them from returning to the system.
"Our main goal is to ensure that individuals, when they are picked up on the street, are taken to a facility," he said. "And that facility is where the triage happens, and they can walk out with a treatment plan or a referral to another system."
However, he said, there isn't enough money to ensure that "they would walk out and be able to go to a treatment facility" --- especially under the Marchman Act.
Florida ranks 49th of the 50 states in per capita funding for mental health services.
Still, Harrell and Garcia say they expect this year's bill --- by streamlining the systems --- will save money and pave the way for future expenditures.
For instance, the bill directs the Agency for Health Care Administration and the Department of Children and Families to develop a plan to increase federal funding for behavioral health care.
Fontaine, of the Florida Alcohol and Drug Abuse Association, said money set aside in 2015 and 2016 will allow about a dozen communities to put into effect the bill's call for a single point of access. That money totals $20 million over the two years.
Among other things, the bill would tighten performance measures for what are known as behavioral health "managing entities," which oversee mental-health and substance-abuse treatment services by region.
Garcia said the bill will help to remove the stigma faced by people struggling with addiction and mental illness.
"The first thing is to make sure that we as a state identify that there is a problem," he said. "The problem is making sure that we get people out of the shadows, and into treatment. Let's not treat mental health as a separate disease, but as a disease like any other disease."